The response of the primary motor cortex to neuromodulation is altered in chronic low back pain : A preliminary study

Journal article

Schabrun, Siobhan M., Burns, Emma, Thapa, Tribikram and Hodges, Paul. (2018). The response of the primary motor cortex to neuromodulation is altered in chronic low back pain : A preliminary study. Pain Medicine. 19(6), pp. 1227-1236. https://doi.org/10.1093/pm/pnx168
AuthorsSchabrun, Siobhan M., Burns, Emma, Thapa, Tribikram and Hodges, Paul
Abstract

Objective
Neuromodulation is increasingly investigated for the treatment of low back pain (LBP). However, the neurophysiological effects of common neuromodulatory techniques (anodal transcranial direct current stimulation [tDCS] and peripheral electrical stimulation [PES]) have not been investigated in people with chronic LBP. Here we aimed to compare the effect of three neuromodulatory protocols (anodal tDCS, high intensity PES, and a priming protocol of combined tDCS/PES) on primary motor cortex (M1) excitability in people with and without chronic LBP.

Design
Cross-sectional.

Setting
University laboratory.

Participants
Ten individuals with chronic LBP and 10 pain-free controls.

Methods
Participants received four interventions in random order across separate sessions: 1) anodal tDCS to M1 + PES to the back muscles; 2) tDCS + sham PES; 3) sham tDCS + PES; or 4) sham tDCS + sham PES. Motor cortical excitability (map volume, discrete map peaks, and cortical silent period [CSP]) was measured before and after each intervention.

Results
Anodal tDCS increased M1 excitability (increased map volume and reduced CSP) in controls but had no effect in the LBP group. PES reduced M1 excitability in both groups. The combined tDCS + PES treatment increased M1 excitability in the LBP group but had no effect in controls.

Conclusions
The neurophysiological response to common neuromodulatory treatments differs between people with and without LBP. This has relevance for the design and tailoring of neuromodulation in pain. Further, if the goal of treatment is to increase M1 excitability, a priming protocol (e.g., combined tDCS + PES) may be more effective than tDCS alone.

Keywordschronic low back pain; peripheral electrical stimulation; primary motor cortex; transcranial direct current stimulation; transcranial magnetic stimulation
Year2018
JournalPain Medicine
Journal citation19 (6), pp. 1227-1236
PublisherOxford University Press
ISSN1526-2375
Digital Object Identifier (DOI)https://doi.org/10.1093/pm/pnx168
Scopus EID2-s2.0-85050622513
Research or scholarlyResearch
Page range1227-1236
Publisher's version
License
All rights reserved
File Access Level
Controlled
Output statusPublished
Publication dates
Online17 Jul 2017
Publication process dates
Deposited18 Aug 2022
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